Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.71 / $42.89 / $226.69	Facility	26	$38.71	$42.89	$226.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.28 / $86.70 / $286.00	Professional		$61.28	$86.70	$286.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $113.88 / $113.88 / $113.88	Professional	25	$113.88	$113.88	$113.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.86 / $43.04 / $183.00	Professional	26	$35.86	$43.04	$183.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.05 / $28.31 / $71.59	Professional	TC	$21.05	$28.31	$71.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $71.87 / $79.86 / $145.00	Professional		$71.87	$79.86	$145.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.87 / $35.34 / $68.79	Professional	26	$28.87	$35.34	$68.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.47 / $87.68 / $193.74	Professional		$63.47	$87.68	$193.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.05 / $55.01 / $108.54	Professional	26	$41.05	$55.01	$108.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.71 / $31.30 / $82.31	Professional	TC	$21.71	$31.30	$82.31
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $67.04 / $95.28 / $205.91	Professional		$67.04	$95.28	$205.91
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $42.84 / $60.82 / $122.99	Professional	26	$42.84	$60.82	$122.99
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $24.12 / $34.28 / $86.44	Professional	TC	$24.12	$34.28	$86.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.65 / $41.65 / $41.65	Facility	26	$41.65	$41.65	$41.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.68 / $94.57 / $242.78	Professional		$64.68	$94.57	$242.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.47 / $54.60 / $129.05	Professional	26	$40.47	$54.60	$129.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.39 / $41.29 / $124.55	Professional	TC	$23.39	$41.29	$124.55
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $57.91 / $97.30 / $131.36	Professional		$57.91	$97.30	$131.36
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.06 / $44.47 / $54.95	Professional	26	$37.06	$44.47	$54.95
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.85 / $56.60 / $76.41	Professional	TC	$20.85	$56.60	$76.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $71.87 / $89.80 / $170.66	Professional		$71.87	$89.80	$170.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.26 / $40.70 / $88.73	Professional	26	$33.26	$40.70	$88.73
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.55 / $56.60 / $112.70	Professional	TC	$41.55	$56.60	$112.70
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.71 / $142.68 / $178.60	Facility	26	$85.71	$142.68	$178.60
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $568.04 / $568.04 / $640.95	Professional		$568.04	$568.04	$640.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $236.22 / $236.22 / $288.98	Professional	26	$236.22	$236.22	$288.98
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $285.88 / $285.88 / $351.98	Professional	TC	$285.88	$285.88	$351.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $51.90 / $108.67	Professional		$32.34	$51.90	$108.67
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $41.65 / $41.65 / $41.65	Facility	26	$41.65	$41.65	$41.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $68.23 / $103.25 / $217.55	Professional		$68.23	$103.25	$217.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $40.61 / $52.75 / $103.82	Professional	26	$40.61	$52.75	$103.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $23.39 / $38.57 / $91.60	Professional	TC	$23.39	$38.57	$91.60
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $237.95 / $237.95 / $237.95	Professional		$237.95	$237.95	$237.95
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $126.70 / $126.70 / $126.70	Professional	26	$126.70	$126.70	$126.70
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $111.24 / $111.24 / $111.24	Professional	TC	$111.24	$111.24	$111.24
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $75.28 / $86.86 / $108.20	Professional		$75.28	$86.86	$108.20
United Facility/Professional Professional Modifier Low / Median / High Price $52.42 / $72.16 / $167.40	Professional		$52.42	$72.16	$167.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.52 / $42.61 / $97.21	Professional	26	$30.52	$42.61	$97.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.46 / $30.69 / $78.09	Professional	TC	$19.46	$30.69	$78.09